Application of a Robotic Telemanipulation System in Stereotactic Surgery

Abstract

To assess the clinical usefulness, accuracy, and safety of telemanipulation for frameless stereotactic surgery using the CAS-BH5 robot system, we prospectively evaluated 10 patients (age: 5–79 years; mean: 44 years) who underwent telemanipulation frameless stereotactic operations from September to December 2005. The CAS-BH5 robot system consists of three main parts: a planning subsystem, a surgical localization subsystem, and a telemanipulation subsystem. Specifically, CAS-BH5 is capable of network communication, video transmission, graphic simulation and human-machine interaction, and thus facilitates remote planning and transmission of neuronavigation data, monitoring and manipulating. Telemanipulation was performed via a digital data network with a speed of 2,000 kilobytes per second by a neurosurgeon in Beijing while the patients were located in Yan’an, 1,300 km away. Remote fiducial registration was performed with a mean accuracy of 1.05 mm and the standard difference between the planned and actual trajectory was 0.13 mm. The mean time from fiducial registration to closure was 30.2 ± 1.66 min. At 12-month follow-up, 90% of patients had improved neurologically. There were no complications. This preliminary data indicates that telemanipulation in frameless stereotactic surgeries is feasible, reliable and safe. In the future, we believe that telemanipulation will facilitate collaboration between surgeons, enhance training, allow for sharing of resources, and have wide applications in the field of neurosurgery.

The Anatomy of Teleneurosurgery in China

“…The real turning point of telemedical applications in China came in 2005 when telemanipulation/teleneurosurgery was conducted to remove brain tumours using image-guided keyhole surgery technique [5], after informed consent had been obtained in advance with local ethical committees. The operating distance is 1300 kilometres away in Yan'an, a mountainous region, from Beijing, with a home-made frameless stereotactic surgical robotic system CAS-BH5.…”

“…The first case of operation on tumour removal was carried out in China in 1997 [5] with a custom-made robot, CAS-R-2. In the following 10 years, over 2000 cases of operations have been carried out by it with total effect rate of 93.3% [39].…”

“…With the advent of World Wide Web, many internet-based services are available and more importantly are free, such as Skype, making the services of teleconferencing/consultation not only affordable but also flexible and portable, that is, a network connection being able to set up in an operation room instead of confining to a conference room, bringing visions of practical applications, such as telesurgery into a reality. Subsequently, the first case of teleneurosurgery took place in 2005 between Beijing and Yan'an with a distance of around 1300 kilometres, performing an operation of tumour removal via a keyhole [5]. …”

Medical Informatics in China: Healthcare IT Trends, Academic and Research Developments

“…The accuracy of position and improvement of findings were observed and related to success in surgery. Compared with the traditional frame stereotactic operations, this method has advantages, such as releasing the patient's pain, is convenient for physicians, extending the range of indicators and increasing the safety and effectiveness of the operations [13,14].…”

Introduction to Haptics for Neurosurgeons

“…Frameless stereotaxy occurs longdistance through the use of teleoperation in China. 13 As a result of technical limitations and the legal and ethical issues associated with long-distance patient care, the vast majority of contemporary telesurgical systems operate in settings where the surgeon and his/her team are proximally located and provide direct supervision of the system themselves. Thus, this article focuses on applications for which the proxy is nearby, ie, in the same room or building.…”